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High-altitude pulmonary edema: the intercellular network hypothesis.

Jean-Paul Richalet1, Florence Jeny1,2, Patrice Callard3

  • 1UMR INSERM U1272 Hypoxie & Poumon, Université Sorbonne Paris Nord, Bobigny, France.

American Journal of Physiology. Lung Cellular and Molecular Physiology
|July 4, 2023
PubMed
Summary
This summary is machine-generated.

High-altitude pulmonary edema involves complex cellular responses to hypoxia. This review details how hypoxia affects the alveolo-capillary barrier, leading to fluid accumulation in the lungs.

Keywords:
endothelial cellextracellular matrixinflammationpneumocytes P2smooth muscle cell

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Area of Science:

  • Pulmonary Medicine
  • Cellular Physiology
  • High-Altitude Physiology

Background:

  • High-altitude pulmonary edema (HAPE) pathophysiology is linked to hypoxic pulmonary vasoconstriction.
  • Other cellular mechanisms contributing to HAPE remain poorly understood.
  • The pulmonary acinus, crucial for gas exchange, is sensitive to acute hypoxia.

Purpose of the Study:

  • To review the cellular mechanisms underlying HAPE.
  • To elucidate the role of the alveolo-capillary barrier's cellular network in HAPE.
  • To explore how acute hypoxia impacts various cell types within the pulmonary acinus.

Main Methods:

  • Literature review focusing on cellular responses to acute hypoxia in the pulmonary acinus.
  • Analysis of intercellular communication within the alveolo-capillary barrier.
  • Examination of humoral and tissue factors involved in HAPE.

Main Results:

  • Hypoxia impairs alveolar epithelial fluid reabsorption.
  • Endothelial and epithelial permeability increase due to junctional alterations.
  • Inflammation, extracellular matrix disruption, and vasoconstriction are triggered by hypoxia.
  • Fibroblast and pericyte functions are altered, affecting barrier integrity.
  • All components of the alveolo-capillary barrier are affected by acute hypoxia, causing edema.

Conclusions:

  • HAPE results from a complex interplay of cellular responses to hypoxia affecting the entire alveolo-capillary barrier.
  • Understanding these cellular mechanisms is crucial for developing HAPE treatments.
  • The delicate balance of the alveolo-capillary barrier is highly susceptible to acute hypoxic insult.